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This is VAERS ID 269194

Case Details

VAERS ID: 269194 (history)  
Form: Version 1.0  
Age: 24.0  
Gender: Female  
Location: Wisconsin  
Vaccinated:2006-10-24
Onset:2006-10-24
   Days after vaccination:0
Submitted: 2007-04-06
   Days after onset:164
Entered: 2006-12-18
   Days after submission:108
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0637F / 2 UN / IM

Administered by: Private       Purchased by: Private
Symptoms: Abdominal pain, Suprapubic pain
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: None
CDC Split Type: WAES0611USA04226

Write-up: Information had been received from a physician concerning a patient who on an unspecified date was vaccinated with the second dose of Gardasil (yeast). Subsequently the patient experienced abdominal pain and suprapubic pain that radiated to the vaginal region. No further details were provided. Additional information has been requested. This is in follow-up to report (s) previously submitted on 12/14/2006. Information has been received from a physician concerning a patient who on 24-OCT-2006 was vaccinated intramuscularly with the second dose of GARDASIL (lot # 653937/0637F). Subseqently on 24-OCT-2006, the patient experienced abdominal pain. The abdominal pain was described as being located at the umbilicus to genital area. The abdominal pain spontaneously resolved 3 days after the vaccination. No further details were provided.


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